More than 4 concurrent cases becomes "medical supervision". See below excerpt from the Medicare Provider Manual. I have attached the link for full information. See Section 50.
D. Payment at Medically Supervised Rate
Carriers may allow only three base units per procedure when the anesthesiologist is involved in furnishing more than four procedures concurrently or is performing other services while directing the concurrent procedures. An additional time unit may be recognized if the physician can document he or she was present at induction
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